Chaeyoun Oh

Right iliac arterial aneurysm in a 4-year-old girl who does not have a right external iliac artery

Pediatric arterial aneurysm is rare disease. Among them, idiopathic-congenital arterial aneurysm is extremely rare. This is a case report of right common iliac artery idiopathic aneurysm with absence of right external iliac artery. A 4-year-old girl who had been complaining of intermittent abdominal pain since 2 years prior presented with a right lower abdominal mass that had been palpable since 6 months prior. Abdominal CT revealed a 5.2 cm × 4.5 cm × 5.1 cm, right-sided, partially thrombosed, saccular, iliac artery aneurysm. She underwent to operation, aneurismal resection. A pathological examination confirmed that it was a true aneurysm, considering that all layers of the vascular wall were stretched with no deficit. The patient was discharged 3 days after the surgery without any complication. Five months passed since the surgery, and the patient is doing well without any abdominal or leg pain.

Inguinal hernia in preterms in neonatal intensive care units: Optimal timing of herniorrhaphy and necessity of contralateral exploration in unilateral presentation

BACKGROUND We sought to determine the optimal timing of IH repair in preterms and the need for routine contralateral exploration. METHODS Medical records of 3690 pediatric patients who underwent unilateral IH repair between January 1998 and December 2009 were reviewed. We assessed medical record review and telephone interviews. In total, 1990 patients were enrolled in the study. Early, early-delayed, and late repair were defined as herniorrhaphy performed within 7 days of diagnosis, later than 7 days of diagnosis, and after discharge from the NICU, respectively. RESULTS Of 1990 patients, 90 preterms and 1900 full-terms were included. Among these, 7, 11 and 72 preterm patients received early, early-delayed and late IH repairs, respectively. Preoperative incarceration and postoperative complication rates were not different, but the recurrence rate was higher in the early repair group. Two group analysis of early and early-delayed vs. late repairs indicated similar results. The rates of synchronous and metachronous bilateral IH (SBIH, MBIH) were observed to be higher and the diagnostic interval of MBIH was shorter in preterms than in full-terms (35.6% vs. 15.9%, P < 0.001; 12.2% vs. 6.3%, P < 0.001; 5.2 vs. 41.8 months, P = 0.003). CONCLUSION Our results indicate that IH repair is safe to perform in preterm babies in the NICU at a delayed or late stage since the preoperative incarceration and recurrence rates were not different. Contralateral exploration could be considered in preterms because the rates of SBIH and MBIH were significantly higher and the MBIH diagnosis interval was shorter than in full-terms. LEVEL OF EVIDENCE III, treatment study.

Ultrasound guided percutaneous internal jugular vein access in neonatal intensive care unit patients

BACKGROUND/PURPOSE Internal jugular vein (IJV) access is commonly performed in neonates and infants with open cut-down method. We report the results of ultrasound guided percutaneous venous access in newborn patients in the neonatal intensive care unit (NICU). METHODS We retrospectively examined the medical records of NICU patients who underwent therapeutic percutaneous IJV access under ultrasound guidance from October 2015 to May 2015. Under general anesthesia, IJV was punctured with a 21 gauge needle after identification by ultrasound. Catheter was inserted with Seldingers technique. RESULTS Twelve ultrasound-guided percutaneous IJV accesses were performed in eight patients and eleven cases were successful (91.6%). Procedure was performed at the median age of 4.5days (range 2days-47days). Median body weight was 3030g (range 1760g-4100g) and median operative time was 19minutes (range 8minutes-80minutes). Indications for central venous access were hyperammonemia caused by urea cycle defect (four patients) and mitochondrial disease (one patient), acute kidney injury (two patients), and congenital renal dysgenesis (one patient). Catheters were inserted in the right IJV in nine cases while two cases were done on the left IJV. All catheters functioned normally. Seven out of seven cases that were examined for venous patency by ultrasonography after catheter removal showed patent IJV. Among these seven cases, four reinsertions were attempted and successfully performed. There was one complication of hemopericardium with cardiac tamponade which is thought to be caused by direct injury from the guidewire. The patient underwent pericardiocentesis. CONCLUSION Ultrasound guided IJV access in NICU patients can be performed safely and is associated with preserved venous patency after catheter removal.